Endoscopic Submucosal Dissection for Superficial Gastric Neoplasia - A Feasible Option in Malaysia

OBJECTIVE:This report aims to describe the feasibility and efficacy of ESD in a tertiary centre in Malaysia.METHODS:ESD for early gastric lesions was initiated at the our centre in 2009 and a retrospective review of all cases was conducted. ESD was performed in a standard manner with the IT knife. Details of the procedures, complications, specimens resected and recurrence at follow up were analysed. RESULTS:Total of six cases (mean age 68 ± 14 years, 5/6 females) of ESD for superficial gastric lesions have been performed. 5/6 lesions were located in the antrum/ pre-pylorus and the median size was 30 (15-60) mm. Endoscopic appearance as defined by the Paris classification were as follows: type 0-IIa + 0-IIc lesion n=3, type 0-Is n=2 and type 0-IIc n=1. En-bloc resection was successful in 5/6 lesions, with a median procedure duration of 135 minutes (72-240 minutes). There were no cases of perforation, significant bleeding nor mortality. Histologically, 5 en-bloc samples showed complete resection (R0). 4 cases confirmed early gastric cancer and 2 cases were non-malignant. Median follow up period of 148 (32-224) weeks, recurrence was only in 1 case. CONCLUSION:ESD for gastric lesions is feasible in Malaysia, despite a low volume of such lesions and a steep learning curve for the procedure.